Building  an  online  repository  of  teaching  resources  to  facilitate  consistent  and  good  quality  teaching  of  postgraduates  and  

undergraduates  in  medicine  –  a  preliminary  report    

Dr  Goh  Poh  Sun  MB,BS(Melb),  FRCR,  FAMS,  MHPE(Maastricht)  Associate  Professor  and  Senior  Consultant  

Department  of  DiagnosFc  Radiology  NaFonal  University  Hospital  

NaFonal  University  Health  System  Singapore  

Conclusions  

•  An  online  case  repository  of  teaching  resources  supports  undergraduate  and  postgraduate  teaching  and  learning  in  radiology.    

•  A  new  iniFaFve  to  build  an  insFtuFon  wide  case  repository  has  the  potenFal  to  have  a  wider  significant  impact  in  medical  educaFon.  

The  following  are  the  feedback  from  reviewers  with  regard  to  the  extended  abstract  (ID:  063):    •              Abstract  needs  to  focus  why  this  is  different  from  other  online  medical  repositories  which  might  be  FREE.  •              What  next  for  this  repository?  What  are  the  unique  features  of  this  repository  other  than  the  contents?  •              It  would  be  good  if  some  findings  on  the  use  of  the  repository  be  shared  –  e.g.  how  the  repository  has  impacted  students’  learning.  

Why  this  iniFaFve  is  different?  

ThemaFc  Experience  Stroke  and    Mimics  

Use  of  repository,  impact  on  learning  

Over  40,000  Page  Views  Over  2  Years  

Residents  Report  That  SystemaFc  Review/Deliberate  PracFce  With  Theme  based  Cases  Significantly  Increases  Their    Confidence  in  both  EMD,  and  day  to  day  Neuroradiology  ReporFng    This  is  Supported  by  Actual  Day  to  Day  Clinical  Performance  Assessment  by  Supervising  Radiologists    (paper  in  dra`  revision)  

What  next?  

CaseBasedLearning@NUHS  Learning@NUHS  

CurriculumMapping@NUHS        

Mastery  Training  in  Radiology  –  Use  in  the  Diagnosis  and  Management  of  Acute  Ischaemic  Stroke  on  CT  Scan    

Dr  Goh  Poh  Sun  MBBS(Melb),  FRCR,  FAMS,  MHPE(Maastricht)  

Department  of  DiagnosFc  Radiology  NaFonal  University  Hospital  

NaFonal  University  Health  System  Singapore  

Pre-­‐Test  (2  parts  –  diagnosis  and  management)  1.  Acute  /  Hyperacute  Infarct  on  CT  (range  of  cases),  admit/thrombolyse  2.  Look-­‐alikes  of  acute  CVA  eg.  Tumour,  EncephaliFs,  admit/treat  3.  Subacute/Chronic  Infarct,  consider  outpaFent  follow  up  

Learning,  followed  by  Deliberate  PracFce  +  Feedback  

Fail   Pass  

Post-­‐Test  (2  parts  –  diagnosis  and  management)  1.  Acute  /  Hyperacute  Infarct  on  CT  (range  of  cases),  admit/thrombolyse  2.  Look-­‐alikes  of  acute  CVA  eg.  Tumour,  EncephaliFs,  admit/treat  3.  Subacute/Chronic  Infarct,  consider  outpaFent  follow  up  

Standard  sefng  by  panel  of  radiologists,  and  neurologists  using  online  repository  

References  

•  hgp://meded.ucsf.edu/radme/medical-­‐educaFon-­‐expert-­‐william-­‐mcgaghie-­‐address-­‐ucsf-­‐simulaFon-­‐based-­‐medical-­‐educaFon  

•  hgp://www.royalcollege.ca/portal/page/portal/rc/common/documents/events/icre/2012proceedings/competency_based_residency_educaFon/mastery_learning_of_clinical_skills.pdf  

2013  AssociaFon  for  Medical  EducaFon  in  Europe  Annual  Conference,  Prague    PS  Goh.  An  online  case  repository  facilitates  radiology  residency  training  and  evaluaFon  of  educaFon  theory,  can  potenFally  shorten  duraFon  of  training,  and  aid  mastery  training  -­‐  a  follow  up  report  

2012  AssociaFon  for  Medical  EducaFon  in  Europe  Annual  Conference,  Lyon  PS  Goh.  An  online  repository  facilitates  radiology  residency  training  and  evaluaFon  of  educaFon  theory  

2011  AssociaFon  for  Medical  EducaFon  in  Europe  Annual  Conference,  Vienna  PS  Goh,  G  Sundar,  C  Tan,  ME  Nga,  TP  Thamboo,  S  Amrith.  CreaFon  and  Use  of  An  Online  MulFspecialty  Case  Repository  and  Its  MulFple  Uses  for  Specialist  Training.  

2009  AssociaFon  for  Medical  EducaFon  in  Europe  Annual  Conference,  Malaga  PS  Goh,  J  Tam.  Deliberate  distributed  pracFce  with  paired  and  mixed  examples  is  an  efficient  and  effecFve  method  to  learn  key  abnormaliFes  on  the  CXR  

2010  7th  Asia  Pacific  Medical  EducaFon  Conference,  Singapore  PS  Goh,  J  Tam.  Applying  deliberate  pracFce  to  chest  radiology  teaching  –  further  work  with  undergraduates  and  experience  with  postgraduates  

8th  Asia  Pacific  Medical  EducaFon  Conference,  Singapore  PS  Goh.  Deliberate  PracFce  Using  Paired  and  Mixed  Examples  of  Imaging  AbnormaliFes  on  the  CXR  is  more  effecFve  and  efficient  for  postgraduate  training  compared  with  tradiFonal  methods  

6th  Asia  Pacific  Medical  EducaFon  Conference,  Singapore    PS  Goh,  J  Tam.  ApplicaFon  of  EducaFonal  Theory  Regarding  Teaching  for  Skill  Transference  for  Chest  Radiograph  InterpretaFon  in  Undergraduate  EducaFon  and  Training  

2008  AssociaFon  for  Medical  EducaFon  in  Europe  Annual  Conference,  Prague  PS  Goh  EvaluaFon  of  a  Radiology  eLearning  program  –  key  factors  contribuFng  to  success  

EducaFonal  Sefng  –  Radiology  Department,  Postgraduate  Training  30  Consultants  –  30  Residents  in  Training  

Current  Digital  /  Online  Teaching    and  Learning  Case-­‐Based  Cases  

Online  Digital  Repository  and  Examples  of  Its  MulFple  Uses  

ThemaFc  Experience  Stroke  and    Mimics  

Short  Theme  Based  InstrucFonal  Video  PresenFng  Unknown    Cases  or  Cases  with  AnnotaFons  and  Answers  

Visual  ThemaFc  Index  –  Stroke  and  Mimics  à  So  you  teach,  have  designed  an  Evidence  Based/Literature  Supported  Curriculum  and  ProgrammaFc  Assessment  Strategy  …    Now  show  me  what  you  actually  teach  “with”,  and  what  you  assess  “on”  …  Range  …  Breadth  and  Depth  

Text  based  Hyperlinked    Case  Index  

For  rare  condiFons    Hyperlinking  to  other  Online  Repositories  

www.ajnr.org    

www.eurorad.org    

Not  just  confined  To  Radiology  Examples  

www.nejm.org    

Imagine  the  teaching  and  learning  possibiliFes  with  1000s  of  cases  in  eBook  format  on  (internet  enabled)  tablets  /  

smartphones    

Imagine  if  the  cases  can  be  selected,  grouped  and  reordered  to  fit  any  learning  or  teaching  purpose  

IllustraFon  examples  from  “Apple”  and  “Samsung”  Company  websites    

More  examples  of  scholarship  potenFal  –  ThemaFc  eBook  Chapters  

Conclusions  

•  An  online  case  repository  of  teaching  resources  supports  undergraduate  and  postgraduate  teaching  and  learning  in  radiology.    

•  A  new  iniFaFve  to  build  an  insFtuFon  wide  case  repository  has  the  potenFal  to  have  a  wider  significant  impact  in  medical  educaFon.  

Advantages  of  online  case  repositories  

•  For  Tutors  –  Online  repository  facilitates  access  –  Unannotated  case  images  give  greatest  flexibility  for  repurposing  and  different  educaFonal  usage  

–  URL  linkage  for  each  case  allows  easy  incorporaFon  of  case  material  on  websites,  blogs  etc.  (this  addresses  the  issue  of  copyright  à  use  a  hyperlink,  similar  to  a  citaFon  in  tradiFonal  academic  publicaFon)  

•  For  Residents  –  Online  case  repositories  can  be  an  efficient  method  for  reviewing  many  cases  

–  Facilitates  personalized,  customized  self-­‐directed  or  guided  learning  

Problems  Using  RLO  Approach  

•  Formalizing  System  and  Procedures  for  Regular  SystemaFc  CollecFon  of  RLOs  

•  Quality  control  and  peer  review  •  Metadata,  tagging,  labeling  and  finding  resources,  and  ensuring  paFent  confidenFality/anonymity  

•  Lack  of  awareness  in  academic  culture  –  uFlizaFon  and  sharing  

•  Reluctance  to  make  unpublished  teaching  material  publicly  available  

•  Lack  of  reward  systems  and  recogniFon  –  Koppi,  Bogle  &  Bogle,  2005  

Take  Advantage  of  Regular  Clinical  AcFviFes  as  Source  of  RLOs  

•  Day  to  day  work  à  SystemaFc  Case  collecFon  (annotated  in  PACS,  or  use  of  mobile  phone  camera  and  online  repositories)  

•  Weekly  clinical  case  audits  (5%)  à  Good  examples  of  normal  and  discrepancies  used  for  teaching  and  self  directed  learning  

•  Weekly  clinical-­‐radiology-­‐pathology  rounds  à  case  material  reused  for  residency  self  directed  learning  or  assessment  

 

Thank  you